Hand Therapy

Hand Therapy Treatment Techniques

Your first hand therapy session consists of a comprehensive evaluation. Depending on your condition, the session may also include education regarding your condition, the use of a modality, manual therapy, exercises, and instruction in a home exercise program. Together, you and your therapist will develop a treatment plan that is tailored to your specific needs and goals for recovery. Your plan of care and number of visits will be determined during your first visit and will depend on your diagnosis, stage of healing, and your commitment to your own recovery. Our hand therapists have a variety of treatment options available to treat conditions of the upper extremity. We have compiled a list of common treatment techniques and therapeutic modalities along with a brief description.

Treatment Techniques

Wound Care and Dressing Changes: Expert wound management is critical to the successful rehabilitation of the injured hand. Proper wound care reduces the risk of infection and subsequently scarring. Minimizing scarring is crucial in preventing unnecessary stiffness and pain. Your hand therapist will apply dressings chosen specifically for your wound. Dressings are used to prevent infection and to help your wound heal faster.

Scar Management: As your body heals following an injury or surgery, it forms scar tissue. Scarring is good because it closes wounds, but heavy, binding scars can prevent return of normal hand function. The adhesions formed by scar tissue can prevent the return of smooth tendon gliding. Adhesions may also form on bones, muscles, tendons, and/or skin, and thereby limit motion. To gain a soft, supple scar that allows good movement, the scar must be “stressed.” You and your therapist can “stress” and “remodel” your scar by performing scar massage. Massage helps prevent the possible formation of a tender, sensitive scar. A comprehensive scar management program will be developed to help soften and flatten the scar tissue and prevent it from adhering to underlying tissues. Scar management may consist of scar massage and the use of scar suction, scar gel products, paper tape application, and elastomer molds.

Management of Swelling: Swelling and inflammation often occur after an injury, surgery, or trauma. A variety of methods can be used to help decrease swelling including retrograde massage, lymphatic massage, application of kinesiotape, pressure garments, elevation, ice, and exercise.

Desensitization: A common side effect of trauma or surgery is the development of hypersensitivity. The purpose of a desensitization program is to reduce the discomfort or pain in an area sensitive to touch. This is accomplished by desensitizing the sensitive area using a variety of means such as massage, vibration, and textures.

Instrument Assisted Soft Tissue Mobilization (IASTM): This technique involves using special instruments of various shapes and sizes to massage and mobilize tissues. Commonly used instruments include adhesion breakers, GuaSha tissue scrapers, and cupping tools.

Deep Tissue Massage: Deep tissue massage targets the deep tissue structures of fascia and muscles. This type of massage involves applying firm pressure to reach the deeper layers of muscle and fascia. Deep tissue massage techniques focus on the release of muscular tension and are used to break up scar tissue and adhesions that can disrupt circulation and cause pain, limited range of motion, and inflammation.

Range of Motion Program: Range of motion (ROM) exercises are designed to increase movement of joints, muscles, tendons, and nerves. ROM exercises include passive stretching, active ROM, gliding exercises, and blocked motion. A home exercise program will be created to complement the exercises performed in the clinic.

Strengthening Program: Strengthening exercises typically begin once pain levels and swelling have decreased and soft tissues and joints have been stretched. Upper extremity strengthening exercises can include (but are not limited to) theraputty exercises, flexbar exercises, theraband exercises, and weights. A home exercise program will also be developed to assist you in reaching your strength goals.

Therapeutic Modalities

Moist Hot Packs and Paraffin Baths: The application of moist heat prior to treatment helps decrease pain and increase extensibility of joints, muscles, tendons, and scar tissue. Paraffin wax dips are often used in conjunction with moist hot packs to provide a deep heat to tissues prior to massage or stretching.

Cold Therapy: The application of cold can help decrease swelling and pain, and is especially effective in the acute stage of a healing injury when inflammation is still a factor. Cold therapy consists of the use of commercial ice packs, ice cup massage, crushed ice bags, and cold-water baths.

Electrical Stimulation: This is a comfortable electrical modality that is effective at decreasing inflammation and pain and improving blood flow to healing tissues.

Neuromuscular Electrical Stimulation (NMES): This type of electrical stimulation is aimed at stimulating muscles. It can be used to decrease muscle atrophy and assist in muscle re-education and reactivation after a surgery, an injury, or trauma.

Fluidotherapy: This is a dry heat modality used to decrease stiffness, pain and hypersensitivity. Advantages of this heat modality are that exercise can be performed during the treatment and higher temperatures can be tolerated by the patient.

Iontophoresis: This modality uses direct current to drive anti-inflammatory medications into the tissues. It is effective in treating tendonitis-related pain and inflammation.

Ultrasound: Ultrasound is a modality that uses high-frequency sound waves to elevate temperatures in deeper structures. Ultrasound is often used to reduce joint contractures, pain, swelling, and scar tissue.

Patient Education

Education regarding the Diagnosis and the Healing Process: Education is one of the most important aspects of hand therapy. Understanding your condition and the healing process allows you to become an active participant in your own recovery. Our hand therapists use a variety of educational methods including 3-D anatomical models and anatomical diagrams to educate patients regarding their specific conditions.

Home Exercise Program: Home exercise programs are provided to patients at their first visit and are updated throughout the course of therapy. They are customized for each patient based on the stage of healing and progress towards goals. Home programs are intended to reinforce what is performed during therapy sessions. They are the foundation of a successful hand therapy program and require patient dedication and compliance.

Education regarding Joint Protection and Use of Adaptive Equipment: Joint protection involves using techniques and adaptive equipment to minimize the stress and force placed on joints, to reduce pain, and prevent or protect against further joint damage or deformity. Our hand therapists can provide information and advice on equipment and techniques that can make your daily activities easier.

What Our Patients are Saying

We are so grateful for Emily’s wisdom and tenacity during our daughter’s injury. In every possible way, Emily exceeded our expectations. She advocated with the surgeon for us, she was creative in her approach to therapy, and she overturned many obstacles that came our way during recovery. But even more importantly, Emily was kind, fun, and compassionate with our daughter, making this painful journey back to health a positive experience. We have always felt like we were in excellent hands, literally! I cannot recommend Emily and her team enough.

S. Schattenkerk

After requiring surgery for a torn ACL due to a sports injury, Kiley Steinriede from Proliance Sports Therapy guided my journey to recovery from re-learning to walk to returning to play the sports I love. Kiley’s mix of real-world experience, attention to detail, empathy, motivation, care, humor and emotional support is what made it all possible. I couldn’t have done it without her.

D. Fernandez

I would not have had a successful rehabilitation experience were it not for Kiley. She was tirelessly diligent, attentive and knowledgeable about what was best for my post-op ACL rehab at each stage of the recovery process. But more importantly, her humor and care for me as an individual, not just a patient, was the greatest encouragement as I went through physical therapy. Because of her, I looked forward to coming in to sessions and her optimism and charisma no doubt expedited my rehabilitation.

J. Kurtz

Laura Browne has provided excellent and effective physical therapy to both myself and my husband in the past. Now, I am thankful to have her professional knowledge and caring treatment as I struggle with the dual problems of surgery recovery and recurrence of significant lymphedema near the surgical site. Laura fluidly adapts to the limitations that the lymphedema imposes on a “normal” path to surgery recovery, always finding effective exercises to substitute for ones that are not practical for the situation. Throughout, her communication is informative, honest, and encouraging. Laura Browne is a credit to the high standards Proliance seeks in their employees.

A. Stieglitz

Kudos to Proliance Sports Therapy & Rehab for the superb treatment I’ve received over the past several months. A spring ski mishap resulted in my fractured arm near my shoulder and that led to surgery requiring a steel plate with several pins; in the same fall, I tore my rotator cuff in my ‘other’ arm. With both arms basically ‘out of commission’ I was scared and worried about how I’d ever use my arms normally again. Laura has amazed me with all of her knowledge and capability as she has led me through a PT Program that now has me functioning as normally as I was before… I am so thankful that I chose Proliance Sports Therapy for my rehab; should I ever need rehab again, I would choose Proliance in a heartbeat!

Joyce

14 months ago I had total shoulder replacement on my right shoulder at Issaquah Proliance Orthopedics & Sports Medicine. Surgery went great! Started Physical Therapy 1 week later. My Therapist (Cathy Van Lith) discussed my goals with me and set a plan. Everybody is so friendly and nice and make you feel welcome – you feel like family. I still have a long way to go but I know I couldn’t be in better hands. I have friends that have recommended that have gone and they can’t thank me enough for the recommendation.

M. Donah

Only place I’ll go: In the past, we’ve had a hard time finding good medical care. My wife found Proliance via recommendation from her OB who had his hip replaced at Proliance. We have since had 2 surgeries each that have required intense physical therapy at Proliance in Issaquah. The net result is that I won’t go anywhere else in the future. My expectations have been exceeded by both the care I’ve received and the support to get through the PT. Sounds silly I suppose, but I feel like I’m treated like a person, not just a body part that needs fixing. I’ve worked with Emily specifically and her PTs are truly a standout, they are awesome, pushing you while supporting, plus have been completely connected with my surgeon and with each other. If you need care, this is a good choice.

A. Taylor

Patrick understood how difficult it was for me to be sidelined and how frustrated I felt. He pushed me to work harder and celebrated with me when I would hit a goal. Patrick was realistic about timelines, knew when to push me and when to hold me back so I didn’t injure myself again. He also did a great job of making our sessions fun and different. I would highly recommend Proliance Sports Therapy & Rehabilitation. This group of people truly cares about your recovery, goals, physical and emotional well being and long term health. I now feel confident to trail run, bike, ski and have even learned how to rock climb!

J. Sargeant

Kyle Mark was amazing! He patiently rehabbed my knee back and specifically researched exercises that would support my love of tennis, after I tore my meniscus. I left after the expected period of time and was able to resume tennis. Unfortunately, I caused an additional issue within the knee while hiking shortly after recovery and, even though I had moved out-of-state, he suggested exercises to get me back on track. I am 100% back to normal and so thankful that he took the time and shared his knowledge with me. Proliance is lucky to have such a smart, caring and dedicated physical therapist in their office.

After finger surgery four years ago on my left hand and two years ago on my right hand. Stephanie helped me through many therapy appointments. She also instructed me on home exercises. She is very professional and will go the extra mile to get the results we both wanted. I would highly recommend her.

F. Olson